Morphology and Differential Diagnosis. Welcome to Dermatology! No matter what area of medicine or...
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Transcript of Morphology and Differential Diagnosis. Welcome to Dermatology! No matter what area of medicine or...
Morphology and Differential Diagnosis
Welcome to Dermatology!
No matter what area of medicine or surgery you pursue, you will get skin related questions from family, friends, and patients.
The time frame is short, so make the best use of your time. Carry your book with you at all times and try to make it through all the photos.
Suggestions for a Successful Rotation
• Be on Time!
• Be attentive and helpful.
• Do not ask questions or make comments during the patient encounter. Please ask all questions outside the exam room.
• Please do not talk loudly in the hallway.
Macule
Macule
Macule
Patch
Papule
Papules
Papules
Papules
Plaque
Plaque
Plaque
Nodule
Nodule
Nodule
Tumor
Tumor
Tumor
Pustule
Pustule
Vesicle
Vesicle
Vesicle
Bulla
Bulla
Wheals
Wheals
Special Skin Lesions
• Burrow: Thin linear papule or plaque
• Comedone: Follicular papule filled with keratinous plug which is open or closed
• Cyst: Papule or nodule filled with debris
• Telangiectasia: Dilated blood vessel less than 1 mm wide
Burrow
Comedone
Telangiectasia
Cyst
Secondary Lesions
• Scale• Crust• Erosions and ulcers• Excoriations• Fissures• Scars• Lichenification• Atrophy
Scales
Scales
Scales
Crust
Crust
Excoriations
Erosion
Erosion
Ulcer
Ulcer
Ulcer
Fissure
Fissure
Atrophy
Atrophy
Atrophy
Atrophy
Scar
Lichenification
Configuration
• Annular• Arcuate• Geographic• Discrete• Confluent• Serpiginous
• Linear• Reticulated
Annular and arcuate
Linear
Erythema Subitum
Descriptors
• Punctate
• Lichenoid
• Umbilicated
• Scarletiniform, morbiliform
• Leonine
Color
• Pink• Violet• Orange• Blue• Green• Yellow• Black• Brown
Color
• Pink—Pityriasis rosea• Violet—Lichen planus• Orange—Juvenile xanthogranuloma• Blue—Amioderone skin pigmentation• Green—Pseudomonas• Yellow—Xanthomas• Black—eschar• Brown—Café au lait spots
Color
Distribution
Morphologic categories
• Macular-Patch• Papular• Papulosquamous
(scaly papules)• Nodular• Pustular• Vesicular-bullous
• Urticarial• Petechial• Telangiectatis• Burrow• Poikiloderma• Hyperkeratotic/scale• Atrophic
“More is missed by not looking than by not knowing”
M. McKay, M.D.
Procedures
• Liquid Nitrogen
• Electrodessication and curettage
• Biopsy– Punch– Shave– Excision
Seborrheic Keratosis
• Common Skin Tumor of unknown cause.
• Predilection for trunk, scalp, temples
• No malignant potential• Increase incidence with
age• Easily treated with
curettage or cryodestruction
Dermatosis Papulosa Nigra
• Most likely a subtype of seborrheic keratosis
• Malar areas, most commonly on African-American women
Acrocordons (Skin Tags)
• Common, occurring in about 25% of adults
• More common in obese individuals and often develop in pregnancy
• Frictional areas such as neck, axillae, inframammary and groin locations
• Can become irritated or infarcted because of torsion
Dermatofibroma
• Firm papule often with brown pigmentation, most frequently seen on the anterior legs
• “Dimple” sign• May be a reactive
process to an insect bite reaction rather than a tumor
• If multiple, sometimes associated with systemic lupus erythematosis
Dermatofibroma
Keloids
• Hypertrophic scar which extends beyond the area of injury
• May have delayed onset, even up to years after injury
• Can be painful• More common in African-
Americans• Treatment can be difficult and
choices include intralesional steroids, radiation, careful excision, laser ablation
Epidermoid Cyst
Trichilemmal (Pilar) Cyst
Actinic Keratosis
Keratosis Pilaris
• Follicular papules, commonly on extremities
• “sandpaper” feel
• 20% of the population affected
• Worsens in adolescence
• Common in Atopics and icthyosis
• May improve with keratolytics, retinoids, dermabrasion
Keratosis Pilaris
Keratosis Pilaris
Cherry Angiomas
• Benign vascular proliferation
• “senile hemangioma” – don’t use this term with patients
• Usually appear on trunk, start at age 30, increase with age
• Dilated capillaries
• Tx for cosmetic reasons only